Individual
MISS LISA ANN VANETTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
142 BERMUDA VILLAGE DR, ADVANCE, NC 27006-7867
(336) 940-6433
Mailing address
5120 CARVERSHAM CT, WINSTON SALEM, NC 27106-4783
(336) 765-1849
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5554
NC
Other
Enumeration date
06/22/2007
Last updated
07/08/2007
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